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Book_L£j^_|T 



DR. D. HARVEY DILLON, 
President. 



DR, BEVERLY W. SMITH, 
Vice-President. 



DR. E. S. KELLY, 

Secretary. 



LOUISIANA STATE BOARD OF HEALTH 



DR D. HARVEY DILLON. SABINE PARISH. DR. T. T. TARLTON, ST. LANDRY PARISH. 

DR. B. A LEBETTER, ORLEANS PARISH. D. BEVERLEY W. SMITH, ST. MARY PARISH 

DR. HERMAN OESCHSNER, ORLEANS PARISH. DR. G. W. GAINES, MADISON PARISH. 
DR. THOMAS A. ROY. AVOYELLES PARISH. 



Extracts from the Sanitary Code of the Louisiana State 
Board of Health, Concerning Hygiene and Sanitation of 
Schools, with Comments by the Department of Medical 
Inspection. 



DEPARTMENT MEDICAL INSPECTOR 

Medical Inspector, Dr. Sidney D. Porter 
Associate Medical Inspector, Dr. J. A Estopinal 



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The following Rules and Regulations contained in the 
Sanitary Code of the State of Louisiana embrace every phase 
of the hygiene of person and environment that practical appli- 
cation can require in the home and^the schoolroom. 

"With a view to obtain your instant appreciation of the 
importance of putting in practice the said regulations we have 
followed each with such comments as may prove useful and 
may best appeal to the lay mind inexperienced in the opera- 
tion of the Sanitary Laws of our State. 

We have every reason to expect that you may in this way 
become thoroughly informed with just what is required of you 
by the law which exacts that among your other duties as in- 
structors of the young you shall include the teachings of the 
broad, simple principles of hygiene and sanitation while keep-, 
ing the closest possible watch over the health of the pupils 
under your care. 



Section 250 (a) which is part of Section 3, of Act 192, 
of' the Constitution of 1908, says: 

(a) "The Parish or Municipal Health Officer, and the 
Parish or Municipal Superintendent of Public Education and 
the Principal of the school, shall be jointly responsible for the 
execution and enforcement of the following rules and regula- 
tions and all health laws governing the hygiene of the school- 
rooms under their respective jurisdiction." 

No uncertainty can dwell in your minds as to the meaning 
of the above section. 

The joint responsibility of the Parish or Municipal Health 
Officer, the Parish or Municipal Superintendent of Public Educa- 
tion and the Principal of the school in the enforcement of 
the regulations at once insures every probability of practical 



results. The union of responsibility will mean simplicity, wis- 
dom and power — a co-ordination and co-operation into which 
friction and confusion cannot enter— the safe, sane, only way 
of giving movement and energy to useful endeavor. 

The medical services^ so indispensible are assured in the 
skill of the Health Officer; the health of the pupil and the 
proper conditions of his environment are guarded daily by 
direct and vigilant watch of the school Principal, while the 
practical efficiency of the plan is made possible by the direction 
and supervision of the Superintendent of Education. 

Sections 250 (b) and (c). 

(b) "Every schoolhouse hereafter to be erected in this 
State, public or private, must have its plans and specifications 
submitted to the local Board of Health to see whether every 
hygienic detail is carried out, especially with reference to venti- 
lation, light and protection against fire." 

(c) "Every schoolhouse, public or private, or building 
used for school purposes, shall be ventilated in such manner 
as to afford 3,000 cubic feet of air per hour for each adult, 
and a proportionate amount for each child, and lighted in 
such manner as to minimize the eye strain." 

Ventilation, light and protection against fire are three 
things which mean so much that it would require volumes to 
recount their importance. 

Nothing is in so intimate touch with the mysterious springs 
of life and health as air — fresh, pure, bracing air. The cells 
of the blood are gluttons for it, and to be deprived of it totally 
means for the human organism almost instant death. When we 
give any living thing the chemical elements of which air is 
composed we feed it and it thrives. The higher and more 
complex the organism the greater the need of it in abundance 
and purity. In man this necessity is foremost amid all the 
physical conditions that surround him. The greater the abun- 
dance in which air is served to our lungs the greater our growth 



physically, mentally, morally. Therefore the need of so con- 
structing our schoolhouses that our children may spend in 
all security within them while they are in their period of 
greatest development an average of six hours daily during about 
seven years of nine months each. 

Of light as well as- air enough can not be said. Beside 

enabling us merely to see in order to go about our several 
occupations science has proved that light — and by that sun- 
light is meant — is the greatest and surest of disinfectants. If 
the rays of the sun simply emitted light without possessing 
the powerful purifying qualities they have, the brightness of 
sunshine would not be the universal boon that it is. It is the 
cheapest and most potent neutralizer and destroyer which we 
know of the causes of disease. 

In his struggle against the germs of sickness man has dis- 
covered many useful chemicals, yet as effective as they may be 
one single ray of sunlight surpasses them all. To so build 
our schoolhouses that the child may at all times be supplied 
with air in abundance, and with air, light, will promote health 
in the highest sense, and most effectively ward off disease. 

Protection against fire while wholly secondary is yet of 
too great importance to be treated indifferently. We should 
no more trust to luck against fire than we should trust to luck 
against sickness. The State laws governing the construction 
of public buildings provide for every modern means known to 
ward against the danger of fire in public buildings. 

Section 250 (d). 

(d) "The school premises shall be thoroughly drained, 
and no stagnant water permitted to collect; in towns with a 
drainage system, or where an overflow is possible, the school 
site and the entire area of the grounds shall be properly drained 
so as to reduce the ground water level, and the drainage effected 
in such manner as not to contaminate with its effluvia any well, 
cistern or other source of drinking water." 

One of the unhealthy conditions with which most of us 
are familiar is due to stagnant water. Beside exhaling noxious 



vapors due to rotting vegetable and animal matter, thereby 
charging the air with an excess of moisture which even if it 
were pure would be contrary to health, it inevitably serves as 
the breeding place for insects and microbes that gain access 
to the nearest building. If the schoolhouse is nearby the con- 
sequences are self-evident. It is necessary that sunshine and air, 
not water, flood at all times the playground of the school child. 
If stagnant water is drained away the greatest care should be 
observed in removing it for as it is altogether likely to- have 
become contaminated, the danger of draining it into any depres 
sion from which it may gain access to and poison the waters 
of a spring, sometimes a great distance away, or a creek or 
riv^er whose waters are used for drinking is even greater than 
if it were left uridrained. 

Section 250 (e). 

Ce) "The floors of every schoolroom, together with tV 
halls and passages leading thereto, in this State, must be swept 
daily, except on holidays, in the following manner: 

"'1. — It must be done after pupils and teachers have left 
the building. 

"2. — The floors must first be sprinkled with sawdust, mois- 
tened with 2V 2 per cent carbolic acid or 40 per cent solution of 
formaldehyde, or other disinfectant, as approved by the State 
Health Officer, and enough of said moistened sawdust must be 
ased to effectually keep down the dust. 

"3. — All desks, waiscottingj window sills and basements 
ji every schoolhouse in the State must be wiped off daily, ex- 
cept on holidays, with a cloth moistened with formalin bi- 
chloride, or carbolic acid solution, of a strength indicated \>y the 
Health Officer ; and under no condition is any feather duster 
to be used in dusting any part of the furniture or building in 
any schoolhouse of this State." 

The above regulations on the avoidance of contamination 
with dust is of the utmost importance. Dust anywhere and 
^verjrwhere is a direct menace to health, whether in the church, 
place of amusement, railway station or school, for in all o\ 



these places where it is not properly removed or not removed 
at all it represents dried up organic matter of every descrip- 
tion, particularly infected sputum teeming; with microbe life 
capable of transmitting every variety of disease. 

The greatest care should be used in removing dust. To 
charge the atmosphere of the schoolroom with it morning and 
evening with the use of brooms and dusters is a very dangerous 
practice and accomplishes infinitely more harm than if it were 
left untouched at all. 

We often speak of flying dust in the street or the home, or 
in any place of public assembly, as the "dust nuisance." This 
is too mild a term; we should think of it and speak of it only 
as the dust danger — the dust plague. There is no surer medium 
of transmission for the baccilli of typhoid fever, and tuber- 
culosis than dust scattered in the streets by the wind and in the 
schoolroom and the home by our ancient friends, the broom and 
the feather duster. 

Flying dust is a real, not a supposed source of danger 
founded on any theory of science. 

Practical results worthy our closest attention have been 
obtained in certain parts of the country by the removal of 
dust in the proper way: it has been found in several of our 
large cities that in crowded districts inhabited by the poor 
the greatest improvemenf in health has immediately followed 
the laying of modern pavements and the regular cleaning of 
these with the copious use of water. What applies to the 
street in this respect applies with equal force to the interior 
of the home and the school. 

By the scrupulous enforcement of the above regulations 
we shall eliminate another of the great risks of infection. 

In order to sweep the room in the proper way see that a 
supply of carbolic acid and sawdust is always at hand. To 
every gallon of sawdust add six tablespoonfuls of carbolic 
acid mixed in a volume of water sufficient to properly moisten 
that quantity of sawdust. 



Section 250 (f). 
(f) "The urinals and water closets must be connected 
with the sewer system where one exists, when within 1,000 feet 
therefrom; where earth closets are used they must be provided 
with water-tight containers, and the contents to be emptied 
and buried at such frequent intervals as to be at all times 
inoffensive, and not dangerous to health. Said containers, as 
often as necessary to prevent th'e gathering of flies, must be 
painted on the inner surface with crude petroleum and a mix- 
ture of pulverized earth or road dust, and slacked lime in the 
proportion of 16 of the former to 1 of the latter, plentifully 
supplied, and the constant use enjoined. All closets must be 
scrubbed with a disinfectant solution once a week, and kept 
in a sanitary condition at all times." 

The outdoor closet in common use in most country homes 
and schoolhouses should be constructed otherwise than we find 
it, if for no other reasons than those suggested by common 
cleanliness and decency. The part it plays in maintaining or 
destroying health is enormous. Furthermore our knowledge of 
the role played in disease by the house-fly (in recent years 
more properly termed the "typhoid fly") is more than suffi- 
cient to warrant the adoption of rigid preventive measures to 
put an end to the havoc caused by that deadly combination: 
the house-fly and the defective closet. Our knowledge of the 
germ-carrying proclivities of this most filthy and disgusting 
of insects has taught us by experience that untold cases of ty- 
phoid fever and tuberculosis have had their origin in this con- 
stant frequenter of the exposed vault or receptacle of outdoor 
closets. 

Fully 30,000 lives are cut short yearly by typhoid fever 
in the United States. Since we know that the fly is so im- 
portant, a factor in its spread, equaling in this respect either 
impure water or impure milk, how long will it be before public 
sentiment becomes so aroused as to put in practice everywhere 
the simple but effective teachings of sanitation? 

The defective outdoor closet is not only the source of 



much of our typhoid fever; it is also largely responsible — 
more responsible than any other given number of unsanitary 
conditions combined — for the widespread prevalence in our 
southern country of a disease due to the hookworm. The hook- 
worm infests the excreta of its victim, and in this manner, 
while preying on their blood until they are rendered pale, 
dull of intellect and lazy, discharges its eggs, which upon 
hatching, pollute the soil in the neighborhood of badly con- 
structed closets. As the worm possesses the faculty of gaining 
access into the blood by attaching itself to and working its 
way through the skin, and being so minute in size as to be 
practically invisible, we leave you to conclude the ease with 
which it may extend its work through the agency of a defective 
out-door closet. It is conservatively estimated by experts of 
the U. S. Government that fully two millions of people in the 
Southern States are incapacitated for any work on account of 
the hookworm disease. 

Section 250 (g). 

(g) "The use of open receptacles for drinking water in 
schools and of dippers or cups for common use is prohibited. 
The school authorities must supply for holding drinking water 
covered containers provided with faucets, which containers 
must be scoured daily when in use. All teachers and pupils 
must provide themselves with individual drinking cups or 
glasses." - 

There can be no greater menace to the pupil than that 
due to the use of a common cup or dipper in the schoolroom. 
Kemembering that all, or nearly all diseases are traceable to 
germ life and that the route most commonly followed by those 
is through the water we drink, it is easy to foresee and prevent 
the evils which may result from the use of the open water 
container and the common cup. Every imaginable sort of germ- 
life and common filth is apt to be deposited into the "ope\< vater 



container by the dusty air of the schoolroom, and almost any 
disease lurking in the mouth or on the lips of the- pupil, 
whether sick or not, may contaminate the drinking water 
through the dipper or cup. On account of the danger of tuber- 
culosis, or consumption, if for no other reason, put into most 
vigorous practice section (g) of these regulations. See that 
you are provided with a closed bucket or cooler with faucet 
attached end that each student is provided with his own glass. 
Do not forget the ease with which consumption enters the body. 
In the United States alone it is estimated that 150,000 persons 
die of this sickness yearly. 

The rigid practice of section (g) will immediately have an 
mfluence so palpable on the health of the great body of our 
teachers and school children that we shall observe it without 
having to refer to comparative statistics. 

Section 250(h). 

(h) " Every school in the State must have a sufficient num- 
ber of trash or garbage cans for the convenience of the pupils, 
teachers and employees, and said trash cans or garbage cans to 
be emptied at least once daily, except on holidays." 

Garbage unremoved is only another of the many means of 
infecting the air and water upon whose purity health is depen- 
dent, and is at all times the breeding and feeding place of flies. 

Section 250 (i) and (j). 

(i) "No person suffering from any communicable disease 
shall be employed as teacher or janitor in any public school of 
this State. 

(j) "No pupil suffering from any communicable disease 
shall be permitted to attend the public schools of this State." 

Disease in one schoolroom spreads with more rapidity and 
certainty than does disease in a hundred homes. Let persons 
congregate day after day in the same place, and if a single 
one of the whole number is suffering from a communicable 
disease the disease will sooner or later claim the whole number 



as its victims if no precautions are taken. From one school 
disease may spread to a number of homes and thus on until 
the whole population, whatever its size, becomes infected. The 
schoolroom is the most dangerous radiating center, or focus, of 
communicable sickness known — it is the cradle of epidemics. 

Section 250 (k) and (1). 

(k) '"The Municipal or Parish Health Officers should have 
every school within their respective jurisdiction inspected at least 
once a month, on different days, the inspection to be made 
without previous notice being given." 

(1) ''The school authorities shall provide for a medical 
inspection of all schools, public and private, at least once a 
month, with special reference to the existence of contagious or 
infectious diseases, and also the condition of the eyes, ears, 
teeth, nose find throat and general physical condition." 

Practical results in disease prevention will never be entirely 
possible until the pupils of our schools are subjected to a regu- 
lar medical inspection, the more frequent the inspections the 
better. In a very few of our large cities these inspections are 
made daily. We have learned in this manner some startling 
facts about the mischief which disease, generally speaking, 
whether infectious or not, is playing among the school children. 
For example, in quite* a number of the schools as many as fifty 
per cent of the pupils were found to be suffering from some 
derangement of sight or hearing, either congenital or acquired, 
nearly always responsible for the child's unwillingness or inabil- 
ity to learn. 

It is a fact needing no argument and no comment that 
the aptitude of the school child to learn depends as much if 
not more upon his bodily health, as, for example, acuteness of 
sight and hearing and normal state of the nose and throat, 
as upon the manner in which the teacher delivers his or her 
instruction. To receive into 'the schoolroom children whose 
sight or hearing is dull or whose breathing and spee. h are 



10 

i nc ted by some unnatural growth in the nose or throat, all 
of which in most cases can be so easily detected, corrected or 
removed, is one of the most potent factors in retarding the 
development of mental activity among the young. 

Section 250 (m). 

(m) "The State Board of Health will, when desired by 
the State institutions of learning, or the State Pedagogical In- 
stitutes, or the Agricultural Institutes, send their Lecturer on 
Hygiene to deliver a series of lectures on 

' ' 1. — Personal hygiene. 

"2. — School hygiene. 

"3. — Principles and practice of physical training. 

"4. — Alcohol and drug addictions. 

"5. — Contagious and infectious diseases — causes and pre- 
vention. 

"6. — Hygiene of the home and farm." 

The above subjects presented in popular form by the Medi- 
cal Inspectors of the Board will help remove many dangerous 
errors so common to our mode of living — errors born of in- 
attention or ignorance, or both, and which are responsible for at 
least fifty per cent of our diseases and deaths. 

Section 250 (n) and (o). 

(n) "All schoolrooms in the State must be disinfected 
once a week with the formaldehyde-permanganate of potash 
mixture, as indicated in the bulletin on disinfection." 

(o) "Whenever the school has been exposed to the dan- 
ger of communicable disease breaking out among the pupils 
or teachers the school shall immediately be closed and fumi- 
gated before reopening." 

The weekly disinfection of the schoolroom as a matter of 
routine fulfills in the highest measure the expectations of pre- 
ventive medicine. As.it is practically impossible to say just 
when or how infection may enter the schoolroom, and since it 
is apt to exist in the air of the place or attach itself on the 
walls, the floor or the furniture of the room during a certain 



11 

time before entering the system of its intended victims, the 
prime and effective thing to do is to forestall its work by regular 
weekly disinfection. 

When the schoolroom is known to be infected the immediate 
need of closing and fumigating it is imperative. To know 
when it has been infected is therefore the important thing, and 
here the Health Officer and Teacher working toward the same 
end are masters- of the situation. The one unassisted by the 
other would make the regulations impracticable. Co-operation 
is what is sought and what is most needed. To exclude sick 
children from the schoolroom upon the first and mildest sign 
of trouble is no difficult feat. It requires no special training 
to observe (in most cases at a glance) many of the external 
signs of acute illness. The majority of these are accompanied 
by rise in temperature and when any suspicion of fever exists 
the use of the clinical thermometer by the teacher will decide 
the question at once. If sick, the child is sent home and the 
principal of the school notifies the Superintendent of Educa- 
tion and the parents of the fact in writing. Should the 
child's condition develop into some of the rapidly infectious 
fevers, his timely isolation at home and the immediate disin- 
fection of the schoolroom under the orders of the Health Officer 
must inevitably prevent an epidemic. It must be remembered 
that nearly all sickness being due to, microbe life, the most 
rapidly spreading fever in the whole catalogue of disease is at 
once rendered harmless when fought with isolation and dis- 
infection. 

Section 250 (p), (q) and (r). 

(p) "All doors, except those which slide into wall pockets, 
must be hung on double- action hinges. (See Act 73 of 1908.) " 

(q) "A fire drill of pupils and teachers must be held at 
least once a week." 

(r) "Spitting on the floors, walls, etc., must be strictly 
prohibited, and anti-spitting placards placed in every room." 



12 

In all infectious diseases the sputum contains innumerable 
baccilli or germs — the active agents of the infection. These 
survive a considerable time in the expectorations even after the 
latter have dried up and have been set free to circulate in the 
air, mixed with every sort of filth, which finally becomes dust. 
All that is required in order to bring about infection by the 
germs contained in sputum is that they be suspended in the 
air we breathe, or in the water and vessels used for drinking. 
Spitting is, therefore, highly dangerous and should be avoided 
altogether. But where it is impossible to avoid it every pre- 
caution should be taken in order that it shall not contaminate 
the floors of any place of business, or the home or the school. 
To accomplish this the use of cuspidores must be enforced and 
the sputum be disinfected with a solution of bichloride of mer- 
cury, formaldehyde or carbolic acid, as per the Health Officer's 
instructions. 

Section 3, of Act 192, of 1908, creating the State Board of 
Health, provides that it shall afford facilities for vaccination, 
provided the same shall not be made compulsory except in cases 
of children attending the public schools. 

Reg. 88, page 25, of the Sanitary Code says: 
"The school law in reference to vaccination as a condition 
precedent to entry in the public schools shall be rigidly enforced 
by the school authorities. Children shall present a certificate 
that they have been successfully vaccinated within five years, 
or that three unsuccessful attempts have been made with a 
proven virus." 

Dr. D. Harvey Dillon, President of the Louisiana State 
Board of Health, in his discussion of the subject, "Vaccina- 
tion," at the fourth annual conference of Health Officers held 
in Alexandria in June, said: "There is one article in the 
Sanitary Code referring to Vaccination which I am going to 
enforce; I expect to ask the Superintendents of the Parishes, 
the Health Officers, the physicians, and all law-abiding citizens 
to help me in the enforcement of this law." 



13 

Vaccination is a positive protective measure against small 
pox, and in our campaign of educating the people to the impor- 
tance of vaccination in preventing and stamping out small pox 
we should have the co-operation of all the people who are doing 
educational work in any line on this subject for the public good. 

Vaccination when properly done, under the proper anti- 
septic precautions, by a well-qualified medical man, is absolutely 
void of danger. 




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